Raise smoking age to 21, doctors advise

Houston Chronicle

Published 11:15 pm, Tuesday, October 27, 2015

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The American Academy of Pediatricians on Monday recommended raising the minimum age to buy tobacco products and electronic cigarettes from 18 to 21, troubled about the continuing public health threat to children, adolescents and adults.

In a wide-ranging new report, the group outlined sweeping recommendations aimed at reducing tobacco and nicotine use in youth, including greater federal regulation, higher prices, creation of more comprehensive no-smoking zones and a ban on flavored products.

“These are commonsense recommendations, backed by strong evidence from research, that can go a long way toward protecting this generation of children and the next,” said Dr. Harold Farber, a Baylor College of Medicine pediatric pulmunologist and the lead author of the report. “We see harm from nicotine from the womb forward.”

Farber acknowledged that the growing popularity of vaping has brought new focus to the issue, but he emphasized that the recommendations concern numerous products currently used by youth — hookahs, small cigars and combustible cigarettes, in addition to e-cigarettes. Noting that 90 percent of adult smokers initiated their tobacco use before their 18th birthday, he said research shows adolescents who experiment with e-cigarettes and more conventional forms are much more likely to go on to become regular smokers and less likely to stop.

The recommendations, which come as the Food and Drug Administration is considering regulations on the $1.5 billion-a-year e-cigarette industry, were presented at the AAP’s national conference Monday and published online in the journal Pediatrics.

Any requirement to raise the minimum age to purchase tobacco would have to be enacted by government. Seven Democrats have introduced such legislation in Congress, but the bill is expected to face heavy opposition from Republicans. Among states, only Hawaii has a law requiring tobacco purchasers be 21, according to the Campaign for Tobacco-Free Kids. About 90 cities and communities in other states have such ordinances.

In Texas, legislation approved last session prohibiting the sale of e-cigarettes to anyone under 18 took effect this month.

‘Going overboard’

E-cigarette industry organizations generally supported 18-and-under bans, now in 47 states, but the leader of one contacted Monday called raising the age to 21 “going overboard.” He said a ban on flavored e-cigarettes would affect 99 percent of such products.

“The AAP has lost sight of the real issue, the need to focus on products that actually kill people,” said Gregory Conley, president of the American Vaping Association, an industry-funded advocacy group. “What’s good for children is to have parents live past 60, something vaping products help accomplish by enabling them to quit when other methods have failed.”

Conley said banning alcohol sales to those younger than 21 hasn’t stopped underage drinking but acknowledged there is a strong argument for such an age prohibition because young people tend to be less responsible about drinking and driving. He said that’s not an issue with cigarettes.

Farber said research shows that adolescents frequently get cigarettes from those in the 18- to 21-year-old range.

Numerous studies have documented the growing popularity of e-cigarettes among children. The Centers for Disease Control and Prevention recently reported that in 2014, surveys found 13 percent of high school students and 4 percent of middle school students reported vaping at least once in the past 30 days, triple the number in 2013. Some studies also have found adolescents and young adults who took up vaping were more likely to start using conventional tobacco products.

The AAP report notes that developing brains are particularly vulnerable to the development of tobacco and nicotine dependence. The vapors emitted by e-cigarettes may contain contaminants such as formaldehyde, a known carcinogen, and diacetyl, which can cause respiratory problems. To small children who happen upon flavored liquid nicotine, small amounts have proved fatal.

Recommendations

A spokesman for a parent company of Philip Morris did not directly respond to questions about the AAP statement but said Congress and state governments should allow the FDA the opportunity to evaluate the science and share its findings before considering proposals to change minimum age laws.

Dr. Lewis Foxhall, vice president of health policy at M.D. Anderson Cancer Center, called the AAP recommendations “a great initiative, putting an emphasis on the range of things that can be done to curtail smoking.” He said he hopes policymakers and the public support “this huge opportunity.”

Other recommendations in the report include better funding for tobacco control, the exclusion of the tobacco industry from the development and implementation of tobacco education and control programs, restricting depictions of tobacco use in movies and other media, making e-cigarette liquid nicotine products come in child-resistant containers and including vaping in no-smoking zones.

“Tobacco is the only consumer product that causes disease and death when used exactly as intended,” said Farber. “Government should heed pediatricians’ calls and protect children from its dangers. It should not take another child to die from poisoning or another teen to become addicted to vaping for us to act.”